How and how to treat urinary incontinence in women: causes and treatment with pills

What reasons?

Due to certain physiological characteristics, urinary incontinence occurs more often in women than in men. Statistics show quite impressive figures - almost half of women over the age of 40 experience uncontrollable urination from time to time.

In total, 35% of young girls and adult women in the Russian Federation are susceptible to this disease. Why it occurs is difficult to answer unequivocally, because there are a huge number of reasons and risk factors .

Under the influence of these factors, changes occur in the body:

the sphincters of the bladder and urethra become weaker and are unable to hold urine;
the muscle walls in the bladder atrophy;
organs and the connections that support them, located in the pelvic area, are deformed due to physical influences;
The bladder and urethra should be securely fixed, but this is not the case.

Let's pay attention to the most common reasons that could influence the changes that have occurred:

gestation and childbirth - during pregnancy, the muscle walls are stretched, and during childbirth, ruptures and damage are possible, which do not always heal correctly;
obesity - it affects bladder function and promotes muscle atrophy;
injuries and surgical interventions - any operations performed on the organs of the genitourinary system could result in complications (for example, removal of the uterus);
some women experience unpleasant symptoms after insertion of a catheter during childbirth;
nervous tension and stress - directly affect the hypersensitivity of the urinary organs;
hereditary causes and congenital defects of internal organs;
changes in hormonal levels due to menopause lead to a lack of elements that maintain muscle elasticity;
in women, unlike men, the diameter of the urethra is several millimeters larger - more force is required to compress it;
Traumatic brain injuries and strokes very often cause symptoms of female incontinence due to their neurological effects on the body.

Symptoms of cystitis

Bladder dysfunction can be temporary, but can last a very long time. L. Gecco et al. (1975) after extended hysterectomy for cancer in 216 patients noted complete restoration of bladder function on average after 24 days.

passive lifestyle;

In 90% of cases, the disease is caused by E. coli; another typical representative of the pathogenic flora that causes this disease is staphylococci. Microbes penetrate through the ascending route - from the rectum or skin through the urethra.

The main cause of this disease is hypothermia. Freezing of the legs and pelvic area is most dangerous. Therefore, you should not sit on cold surfaces, wear thin silk underwear in the cold season, or wear shoes that are too light.

Disorders of bladder function after radical surgery for genital cancer are often severe and occur in almost every third patient [Roman-Loper JJ 1975]. This happens when a urinary infection develops with extensive tissue necrosis and subsequent formation of strictures and fistulas. PH

Smith et al. (1969) analyzed 211 Wertheim operations. The following urological complications were registered: early (difficulty urinating - 45%; urinary infection - 31%; neurogenic disorders - 23%; genitourinary fistulas - 1%); late (difficulty urinating - 22%; stress incontinence - 39%; urinary infection - 20%; neurogenic disorders - 19%).

drink plenty of warm liquids;

In the chronic course of the disease, procedures are prescribed aimed at restoring the outflow of urine. These include, for example, treatment of prostate adenoma, elimination of narrowing of the urethra. It is mandatory to identify and eliminate foci of infection in the body. In chronic forms of cystitis, antibacterial treatment is carried out only after appropriate laboratory tests - urine culture, identification of the pathogen and its sensitivity to antibiotics.

Acute manifestations of cystitis quickly disappear if you eat 0.5-1 liters of lingonberries at one time. But this does not mean that further treatment should be completely stopped.

Warm herbal baths or washing the external genitalia with warm water and soda solution will help relieve the condition after painful urination.

often wear synthetic tight-fitting underwear;

Often, after gynecological and obstetric operations, patients develop cystitis, which can cause bladder dysfunction of various types. According to E. S. Tumanova (1959), of 593 patients who underwent various gynecological operations, 70 (11.8%) had cystitis in the postoperative period.

Chronic urinary retention caused by obstetric or gynecological trauma should be differentiated from bladder diverticula. They usually develop as a result of some congenital defect of the bladder wall, in the presence of obstruction of its neck or urethra. Mostly diverticula are located on the lateral and posterior walls of the bladder.

The most common complications of diverticulum are infection, stones, and tumor. Difficulty urinating and urinary retention are constant symptoms of the disease. Diverticula are easily diagnosed using cystoscopy and cystography. The main method of treatment is to remove the obstacle to emptying the bladder.

do not sit on cold surfaces;

Types of incontinence

Medicine distinguishes several types of incontinence. The most popular forms :

stressful - occurs without a noticeable urge to urinate, during physical activity, tension in the pelvic muscles as a result of coughing, sneezing, or changes in body position.
Urgent (imperative) - first there is a strong urge to go to the toilet, which cannot be tolerated, then uncontrolled release of urine occurs.

There are rarer and more common forms:

enuresis - urination mainly occurs at night during sleep;
constant slight involuntary dripping or excessive leakage of urine, as a result of deformation or displacement of the urinary organs;
mixed type - the presence of several different forms of incontinence, for example, nocturnal (enuresis) and stress, arising due to different factors.

Bladder catheterization technique in men

Before performing the procedure, the doctor must select the appropriate catheter. Typically, a soft catheter is used to catheterize the bladder in men. This makes the manipulation safer and less traumatic. In special cases, metal devices may be used. Also, when choosing a tube, the shape, diameter and time the device is in the bubble are taken into account.

There are continuous (sterile) and intermittent catheterization. Indwelling catheterization is performed at home and in hospital settings. A sterile catheter is installed for a certain period, which prevents infectious processes in the urethra. An intermittent catheter can be used by the patient independently to remove urine. It is administered once a day, without complications or side effects.

The following types of devices are used to perform catheterization:

Silicone catheter (short-term urine drainage);
Nelaton catheter (simultaneous excretion of urine);
Silver catheter (permanent drainage);
Three-channel Foley catheter (urine evacuation, drug administration);
Pezzer catheter (urine excretion using physiological method).

The choice of a suitable device is made by the doctor, taking into account the symptoms and course of the pathological process, as well as the tasks and goals of the manipulation.

What to do?

The problem can be eliminated, and the sooner a woman sees a doctor, the less harm the disease will cause her.

And we are talking not only about physiological factors, but also about psychological ones. The constant fear of involuntary urination literally chains a woman to her home. Phobias and nervous disorders arise. Personal life, including sexual life, and social activity are reduced to zero.

You should immediately contact a urologist if even slight signs of leakage during harmless walking, running, sneezing and other activities.

How to treat cystitis after surgery and catheter

Urological recommendations provide general rules that shorten the period of therapy and reduce the likelihood of recurrence of cystitis:

Relieving inflammation after prolonged use of a catheter inserted into the bladder is problematic. To install a catheter, direct indications are required. Catheterization is performed by a urologist.
Diet - to remove pathogenic microflora, it is necessary to increase the volume of fluid consumed. Alcohol is prohibited after surgery. Canned food, fried and smoked foods are prohibited. You should reduce your salt intake. Preference is given to food that is easily digested by the gastrointestinal tract. Constipation can aggravate the patient's condition after surgery. Kidney and other urological infusions, cranberry and lingonberry fruit drinks will help quickly restore immunity.

Diagnosis of the disease

Determining the cause of the disease and making the correct diagnosis is already half of the treatment. As with any disease, it is necessary to understand the root of the problem in order to effectively combat it.

You will need a comprehensive examination , which includes:

interviewing the patient and collecting anamnesis - the doctor asks questions about the frequency of urination and the time of its appearance, about previous births and surgical interventions, various infectious and neurological diseases experienced;
internal examination of the vagina, pelvic organs and bladder;
ultrasound examination of the genitourinary system and kidneys;
tests for urinary incontinence in a hospital setting;
comprehensive urodynamic examination.

The latter includes several different techniques and procedures:

the pressure in the ureters and bladder is recorded when they are artificially filled with fluid;
the ability of the sphincters, the shut-off valve and the muscles restraining the organs to function under certain loads is checked (cystometry, profilometry and electromyography, respectively);
the patient is prescribed to keep a diary of urination for 3-4 days, where it is necessary to keep detailed records of all voluntary and involuntary cases, the amount of fluid released and the conditions under which this occurred.

In addition, laboratory tests of urine and blood analysis, both general and bacteriological, are required. Check for inflammation of the bladder and ureters. Urethritis and cystitis contribute to the development of incontinence and make adjustments to treatment tactics .

Find out the causes of chronic urethritis in our article.

Cystitis after surgery and catheterization - treatment

Prognosis of bladder complications after surgery Cystitis after abdominal surgery
Cystitis after catheterization

How to treat cystitis after surgery and catheter

The human genitourinary system is sterile. Infection entering organs and ducts leads to an inflammatory process. When undergoing abdominal surgery or installing a catheter, the likelihood of infection increases significantly. To prevent complications, preventive measures are taken.

Despite the measures taken, cystitis after surgery and catheterization remains a fairly common problem. Before agreeing to surgical and diagnostic procedures, it is necessary to learn about possible complications.

Treatment

The doctor decides how to treat the patient based on the data obtained as a result of diagnostic procedures. The state of the body, past and present diseases of the cardiovascular, endocrine and nervous systems are taken into account.

Treatment methods are divided into conservative, medicinal and surgical.

It's time to act

Conservative means include training the pelvic muscles through physical therapy. Kegel exercises have proven themselves both for the prevention and elimination of incontinence by returning the muscles to normal functioning.

The urethral and vaginal muscles are involved, and as a result of their constant contractions with increasing strength and duration, a mild form of incontinence can be cured .

Additionally, you can try biofeedback therapy. It is necessary to control the processes of urination and go to the toilet strictly on schedule .

The method works only when the muscles of the pelvis and internal organs are not damaged and are in good shape (which is facilitated by exercise therapy).

In addition to physical activity, physiotherapy (electromagnetic stimulation) and herbal medicine (teas, infusions and decoctions of beneficial plants and herbs) are prescribed.

Medicines

Drug therapy has been found to be completely ineffective in the fight against urinary incontinence. Drugs are prescribed only for overactive bladder, when surgical intervention cannot be used.

For older women, candles (Ovestin) may be suitable. These hormonal agents help restore the elasticity of the sphincter muscles. It is enough to use one piece once a week .

At a younger age, Spazmex can be taken as a temporary measure. It is based on trospium chloride, a pharmacological substance that can block the urge to urinate by reducing the frequency of spontaneous muscle contractions. Well suited for the urgent form of the disease.

The list of tablets for eliminating this and other forms also includes:

antidepressants - reduce the amount of involuntary leakage during laughter, coughing and physical activity.
Imipramine is a drug against stress and urgency;
anticholinergics (ditropan) - against mixed types of incontinence, although they have many side effects.

Surgical effective means

Almost all interventions of this nature are aimed at eliminating defects and securing the vagus organs in the required position:

Sling surgery is the use of a loop to secure the urethra. The loop consists of a synthetic material that is not rejected by the body and does not dissolve over time.
Urethrocystocervicopexy is an open surgical procedure with a long rehabilitation period. Various techniques are used (Raza, Birch, etc.), as a result of which defects are eliminated and the urethra is fixed.
Endoscopic procedures involve the introduction of a gel into the urethra to improve its functioning.

There is no single scheme for surgical intervention, because each organism has individual characteristics.

Consult a qualified healthcare professional who is experienced in treating various types of urinary incontinence.

Surgical interventions in women with urinary incontinence

Sometimes drug therapy does not improve your condition. If you suffer from stress urinary incontinence, your doctor may recommend surgical treatment. Common surgical treatment options for stress urinary incontinence include:

Sling implantation
Colposuspension - Birch operation
Artificial compression devices
Artificial urinary sphincter
Fillers

The goal of all surgeries is to cure your incontinence.

Together with your doctor, you can decide which method is right for you based on:

your age;
the severity of your incontinence;
severity of symptoms symptoms;
your general health.

Sling implantation

Sling implantation is a standard surgical treatment for stress urinary incontinence in women. The sling provides support for the pelvic floor muscles and helps the urethra resist pressure from a full bladder. The sling is placed under the urethra to support it.

There are different types, depending on:

Material. Slings can be synthetic or made from human or animal tissue
Their shape. Slings can vary in length and width
The way they are attached to the fabric. Which type of mount is recommended for you depends on your individual situation and needs. It also depends on the different types of slings your hospital has and your surgeon's experience with them.

When should I consider a sling?

Sling implantation is the most commonly recommended treatment option for stress urinary incontinence. The sling brings results for stress urinary incontinence in 85-90% of cases. If the operation is successful, the effect is usually long-lasting. Your doctor may also recommend this surgery if you have mixed urinary incontinence. Because surgery only treats the symptoms of stress urinary incontinence, it may be less effective.

How are slings implanted?

The operation is usually performed under local or spinal anesthesia, but in some cases general anesthesia may be recommended. First, the doctor inserts a urethral catheter to ensure that the bladder is completely empty during surgery. An incision is then made in the front of the vaginal wall to insert the mesh prosthesis. The two ends of the sling are placed on either side of the urethra, forming a sling like a hammock. Finally, the ends of the sling are attached to the fabric. In posterior slings, the ends are attached just above the pubic bone. In anterior slings, the ends are attached to the tissue around the groin (Fig. 1a and 1b).

Rice. 1a inner sling Fig. 1b outer sling

How to prepare for surgery?

You should have a urine test before surgery to make sure you don't have a urinary tract infection. If you have an infection, your doctor will prescribe antibiotic therapy before, during, and after surgery. The doctor will inform you in detail about how to prepare for the procedure. If you need general anesthesia, you should not eat, drink or smoke for 6 hours before surgery. If you are taking any medications, tell your doctor. It may be necessary to stop certain medications several days before surgery.

How long will it take me to return to daily activities?

Your doctor will usually remove the catheter within 24 hours after surgery and monitor your condition. You can usually leave the hospital the day after surgery. If you have trouble urinating or have a lot of residual urine after urinating, you may need to stay longer in the hospital. After any surgery, your body needs time to fully recover. The wound can heal within a month.

During this time, you may experience pelvic pain or pain when urinating. You may also have vaginal discharge. Your doctor may prescribe treatment to relieve these symptoms.

Recommendations for 4-6 weeks after surgery:

Drink 1-2 liters of fluid every day
Do not lift anything heavier than 5 kilograms
Do not engage in heavy physical labor.
Take a shower instead of a bath.
Avoid hot baths or saunas
Adapt your diet to prevent constipation

You need to see a doctor or return to the hospital immediately if:

Developed a fever
Can't urinate
You have heavy bleeding or pain
The wound begins to bleed or starts to discharge

Advantages

High chance of curing stress urinary incontinence
Long term solution
Minimally invasive procedure
Fast recovery

Flaws

Risk of bladder injury or perforation
Risk of injury or perforation of the urethra
Risk of injury to the intestines or blood vessels in the pelvis
Risk of temporary urinary retention after surgery
Risk of urinary tract infection
Risk of pain during sex
Risk of lower extremity thromboembolism

Colposuspension – Birch operation

This surgery is used to treat stress urinary incontinence in women. The goal is to realign the bladder neck so that it can better withstand the pressure from a full bladder. Your doctor may recommend this surgery if you suffer from mixed urinary incontinence. Because surgery is intended to treat only the symptoms of stress urinary incontinence, it may be less effective in these cases. When to Consider Colposuspension is an alternative treatment to sling implantation if you have mild to moderate urinary incontinence. Because slings are the most common treatment option for stress urinary incontinence, colposuspension is usually only recommended if they are not the best treatment option for your situation.

How is Burch colposuspension performed?

Birch colposuspension requires general anesthesia. First, the surgeon inserts a urethral catheter into the bladder to make sure it is completely empty. The top of the vagina is then attached to the ligament behind your pubic bone with supporting sutures. This will elevate the bladder neck. (Fig.2). Birch colposuspension can be performed open or laparoscopically. During open surgery, the surgeon makes an incision in the lower abdomen to directly access the pelvis. In laparoscopic surgery, the surgeon inserts ports (small plastic tubes) into the abdomen. Through these ports, the surgeon can insert the instruments needed to perform the operation. One port is used to insert a camera, which allows you to display the image on the monitor (Fig. 3).

Rice. 2 Birch colposuspensions

Rice. 3 Laparoscopic surgery. Use of ports for insertion of instruments.

Laparoscopic and open surgery are equally effective for treating stress urinary incontinence in women. Hospital stay is shorter with the laparoscopic method.

How to prepare for surgery?

How long will it take me to return to daily activities?

Your doctor will usually remove the catheter immediately after surgery and monitor your condition. You can usually leave the hospital a few days after surgery. If you have trouble urinating or have a lot of residual urine after urinating, you may need to stay longer in the hospital. Full recovery from Burch's surgery may take up to 6 weeks. During this time, you may experience occasional pelvic pain and pain or a burning sensation when urinating.

Recommendations for 4-6 weeks after surgery:

Drink 1-2 liters of fluid every day
Do not lift anything heavier than 5 kilograms
Do not engage in heavy physical labor.
Take a shower instead of a bath.
Avoid hot baths or saunas
Adapt your diet to prevent constipation

You need to see a doctor or return to the hospital immediately if:

Developed a fever
Can't urinate
You have heavy bleeding or pain
The wound begins to bleed or starts to discharge

Advantages

High probability of curing stress urinary incontinence by changing the position of the bladder neck
Long lasting effect

Flaws

Risk of bladder injury or perforation
Risk of injury or perforation of the urethra
Risk of temporary urinary retention after surgery
Risk of urinary tract infection
Risk of pain during sex

Artificial compression devices (installation of cylinders)

Artificial compression devices, also known as balloons, are a second-line treatment for moderate to severe urinary incontinence. They compress the urethra just below the bladder neck to better resist the pressure of a full bladder. The purpose of the balloons is to reduce urine leakage during activities such as sneezing, coughing, laughing or running. The artificial compression device consists of a balloon that may contain liquid, a small titanium port and a tube connecting the port to the balloon (Fig. 4). The port allows the doctor to adjust the amount of liquid in the balloons. Two balloons are inserted on either side of the urethra during a minimally invasive procedure.

Rice. 4 artificial compression devices (balloons) compress the urethra

When should you consider cylinder installation? Balloon placement is recommended after previous surgical treatment to treat stress urinary incontinence. Your doctor may also recommend this method in cases where other treatment options are less effective.

How are the cylinders installed?

General anesthesia is usually used for the operation, but in some cases spinal anesthesia may be recommended. First, the surgeon inserts a urethral catheter into the bladder to make sure it is completely empty. Then the incision in the labia is filled. Using X-rays for guidance, the doctor places the first balloon on one side of the urethra, just under the neck of the bladder. This is then repeated with a second balloon on the other side of the urethra. Finally, the doctor places titanium ports in the labia and connects them to the balloons. This is done so that the volume of the balloons can be easily adjusted after surgery.

How to prepare for surgery?

How long will it take me to return to daily activities?

Your doctor will usually remove the catheter immediately after surgery and monitor your condition. You can usually leave the hospital a few days after surgery. If you have trouble urinating or have a lot of residual urine after urinating, you may need to stay longer in the hospital. After any surgery, the body needs time to fully recover. Full recovery from surgery may take up to 6 weeks. During this time, you may experience occasional pelvic pain and pain or a burning sensation when urinating.

Recommendations for 4-6 weeks after surgery:

Drink 1-2 liters of fluid every day
Do not lift anything heavier than 5 kilograms
Do not engage in heavy physical labor.
Take a shower instead of a bath.
Avoid hot baths or saunas
Adapt your diet to prevent constipation

You need to see a doctor or return to the hospital immediately if:

Developed a fever
Can't urinate
You have heavy bleeding or pain

Advantages

High chance of curing stress urinary incontinence
The volume of the cylinders can be adjusted
Does not have a negative impact on possible future surgical treatment

Flaws

Risk of injury to the vagina, urethra, or bladder during surgery
Risk of injury to the intestines or blood vessels in the pelvis
Risk of temporary urinary retention after surgery
Risk of device erosion leading to infection of the bladder, vagina or urethra
Risk of repeated operation in case the device does not work.

Implantation of artificial bladder sphincter (AUS)

Artificial bladder sphincter implantation is a second-line treatment for moderate to severe urinary incontinence. Using a hand pump, the implanted artificial sphincter allows you to control urination by squeezing and unclenching the cuff around the urethra (Figure 5).

Rice. 5 An artificial sphincter is implanted in a woman's lower urinary tract.

The purpose of AUS is to reduce urine leakage during activities such as sneezing, coughing, laughing, or running. The AUS consists of an inflatable cuff that is placed around the urethra, a reservoir to store fluid, and a pump to operate the cuff.

When should artificial bladder sphincter implantation be considered? Typically, AUS is used in difficult cases following previous surgical treatment in which stress urinary incontinence could not be cured or improved. A doctor may recommend it when other treatment options have a low chance of success. A urodynamic test should be performed to ensure that there are no contraindications for this operation. Before surgery, your doctor will explain to you how the device works.

How is AUS implanted?

General anesthesia is usually used for the operation, but in some cases spinal anesthesia may be recommended. First, the surgeon inserts a urethral catheter into the bladder to make sure it is completely empty. An incision is made in the lower abdomen to place a cuff around the urethra. The doctor then places the reservoir. Finally, the pump is placed in the labia and connected to the other two elements of the device (Fig. 5). The cuff remains open until the doctor activates it several weeks later.

How to prepare for surgery?

How long will it take me to return to my daily activities?

Your doctor will usually remove the urethral catheter the day after surgery and monitor your condition. You may need to take antibiotics to prevent infection. If you can urinate without problems and there is not a lot of urine left in your bladder, you will be discharged from the hospital after a few days. After you leave the hospital, it will take time to fully recover from surgery. Because of this, AUS will not activate until your lower urinary tract is completely healed. This means that you will continue to leak urine for several weeks after surgery. During this time, you may experience pelvic pain or pain when urinating. Your doctor may prescribe treatment to relieve these symptoms. Your doctor will schedule an appointment to activate the device 4-6 weeks after surgery.

During the recovery period, your doctor may recommend:

Drink 1-2 liters of fluid every day
Do not lift anything heavier than 5 kilograms
Do not engage in heavy physical labor.
Take a shower instead of a bath.
Avoid hot baths or saunas
Adapt your diet to prevent constipation

You need to see a doctor or return to the hospital immediately if:

Developed a fever
Can't urinate
You have heavy bleeding or pain
Blood in the urine
The wound begins to bleed or starts to discharge

Advantages

A good option if previous surgical treatment has failed
High chance of curing stress urinary incontinence
High chance of returning to normal urination, even if you suffer from severe incontinence

Flaws

Risk of injury to the vagina, urethra, or bladder during surgery
Risk of injury to the intestines or blood vessels in the pelvis
Risk of device erosion in the urethra or bladder neck
Risk of mechanical failure of the device
Requires the ability to control the device manually
You will remain incontinent until the device is activated 4-6 weeks after surgery

Injections with fillers

If you suffer from stress urinary incontinence, your doctor may recommend treatment with fillers. They are inserted into the wall of the urethra so that the urethra contracts and can better resist the pressure of a full bladder. Fillers are injected as a liquid, which then hardens into a spongy material to strengthen the urethral wall. Fillers may consist of synthetic materials or bovine collagen. The effect of the operation wears off over time.

When should filler injection be considered?

Injection with fillers is recommended if you are not a candidate for other surgeries or would prefer to postpone more invasive surgery.

How to administer fillers?

Local anesthesia is usually used for the operation. First, the surgeon inserts a urethral catheter into the bladder to make sure it is completely empty. The endoscope is then used to guide the needle into the wall of the urethra. The doctor inserts fillers on both sides of the urethra (Fig. 6).

Rice. 6 filler is inserted into the wall of the urethra

How to prepare for surgery?

The doctor usually removes the catheter soon after surgery. If you are able to urinate without any problems and there is no residual urine in your bladder, you will be discharged from the hospital.

Within 3-4 weeks, the doctor may recommend:

Drink 1-2 liters of fluid every day
Do not lift anything heavier than 5 kilograms
Do not engage in heavy physical labor.
Take a shower instead of a bath.
Avoid hot baths or saunas
Adapt your diet to prevent constipation
Avoid sexual activity for 1 month.

You need to see a doctor or return to the hospital immediately if:

Developed a fever
Can't urinate
You have heavy bleeding or pain

Advantages

Minimally invasive procedure
Usually does not require general anesthesia
Often performed on an outpatient basis
Does not have a negative impact on possible future surgical treatment

Flaws

Temporary effect
Risk of infection of the urethral wall
Risk of temporary urinary retention

Algorithm for bladder catheterization in men

The technique of bladder catheterization in men requires adherence to certain principles. The male urethra differs from the female urethra in anatomical features. It is narrow and has several physiological narrowings that make it difficult to insert the catheter freely.

Before the procedure, the urethral opening, glans penis and foreskin are treated with an antiseptic solution. The catheter is lubricated with glycerin. The patient lies on his back and bends his legs. A urine bag is placed between the feet to collect urine. Then the doctor, with gentle movements, using tweezers or a napkin, inserts the catheter into the urethra. When the tube reaches the bladder, urine begins to come out. In order for the urethra to be flushed with residual urine, the catheter is removed until all urine is removed.

With permanent catheterization, the tube is connected to a drainage system, which is fixed on the leg (so the patient can move freely). To collect urine at night, large collectors are attached to the bed.